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Clinical effects and treatment of envenoming by Hoplocephalus spp. snakes in Australia: Australian Snakebite Project (ASP-12).
Toxicon 2011; 58(8):634-40T

Abstract

There is limited information on envenoming by snakes of the genus Hoplocephalus from Eastern Australia. We investigated the clinical and laboratory features of patients with definite Hoplocephalus spp. bites including antivenom treatment, recruited to the Australian Snakebite Project. There were 15 definite Hoplocephalus spp. bites based on expert identification including eight by Hoplocephalus stephensi (Stephen's banded snakes), four by Hoplocephalus bungaroides (broad-headed snake) and three by H. bitorquatus (pale-headed snake). Envenoming occurred in 13 patients and was similar for the three species with venom induced consumption coagulopathy (VICC) in all envenomings. Seven patients had an INR >12 and partial VICC, with only incomplete fibrinogen consumption, occurred in three patients. Systemic symptoms occurred in eight patients. Myotoxicity and neurotoxicity did not occur. H. stephensi venom was detected in all three H. stephensi envenomings (1.1, 44 and 81 ng/mL) for whom pre-antivenom blood samples were available, and not detected in one without envenoming. In two cases with post-antivenom blood samples, venom was not detected after tiger snake antivenom (TSAV) was given. In vitro binding studies demonstrated that TSAV concentrations of 50mU/mL are sufficient to bind the majority of free H. stephensi venom components at concentrations above those detected in envenomed patients (100 ng/mL). Eleven patients received antivenom, median dose 2 vials (Range: 1 to 5 vials), which was TSAV in all but one case, where polyvalent antivenom was used. Immediate hypersensitivity reactions occurred in six cases including one case of anaphylaxis. Envenoming by Hoplocephalus spp. causes VICC and systemic symptoms, making it clinically similar to brown snake (Pseudonaja spp.) envenoming. Based on in vitro studies reported here, patients may be treated with one vial of TSAV, although one vial of brown snake antivenom may also be sufficient.

Authors+Show Affiliations

Discipline of Clinical Pharmacology, University of Newcastle, Australia. geoff.isbister@gmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21967812

Citation

Isbister, G K., et al. "Clinical Effects and Treatment of Envenoming By Hoplocephalus Spp. Snakes in Australia: Australian Snakebite Project (ASP-12)." Toxicon : Official Journal of the International Society On Toxinology, vol. 58, no. 8, 2011, pp. 634-40.
Isbister GK, White J, Currie BJ, et al. Clinical effects and treatment of envenoming by Hoplocephalus spp. snakes in Australia: Australian Snakebite Project (ASP-12). Toxicon. 2011;58(8):634-40.
Isbister, G. K., White, J., Currie, B. J., O'Leary, M. A., & Brown, S. G. (2011). Clinical effects and treatment of envenoming by Hoplocephalus spp. snakes in Australia: Australian Snakebite Project (ASP-12). Toxicon : Official Journal of the International Society On Toxinology, 58(8), pp. 634-40. doi:10.1016/j.toxicon.2011.09.013.
Isbister GK, et al. Clinical Effects and Treatment of Envenoming By Hoplocephalus Spp. Snakes in Australia: Australian Snakebite Project (ASP-12). Toxicon. 2011 Dec 1;58(8):634-40. PubMed PMID: 21967812.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical effects and treatment of envenoming by Hoplocephalus spp. snakes in Australia: Australian Snakebite Project (ASP-12). AU - Isbister,G K, AU - White,J, AU - Currie,B J, AU - O'Leary,M A, AU - Brown,S G A, AU - ,, Y1 - 2011/09/28/ PY - 2011/06/20/received PY - 2011/09/15/revised PY - 2011/09/22/accepted PY - 2011/10/5/entrez PY - 2011/10/5/pubmed PY - 2012/3/16/medline SP - 634 EP - 40 JF - Toxicon : official journal of the International Society on Toxinology JO - Toxicon VL - 58 IS - 8 N2 - There is limited information on envenoming by snakes of the genus Hoplocephalus from Eastern Australia. We investigated the clinical and laboratory features of patients with definite Hoplocephalus spp. bites including antivenom treatment, recruited to the Australian Snakebite Project. There were 15 definite Hoplocephalus spp. bites based on expert identification including eight by Hoplocephalus stephensi (Stephen's banded snakes), four by Hoplocephalus bungaroides (broad-headed snake) and three by H. bitorquatus (pale-headed snake). Envenoming occurred in 13 patients and was similar for the three species with venom induced consumption coagulopathy (VICC) in all envenomings. Seven patients had an INR >12 and partial VICC, with only incomplete fibrinogen consumption, occurred in three patients. Systemic symptoms occurred in eight patients. Myotoxicity and neurotoxicity did not occur. H. stephensi venom was detected in all three H. stephensi envenomings (1.1, 44 and 81 ng/mL) for whom pre-antivenom blood samples were available, and not detected in one without envenoming. In two cases with post-antivenom blood samples, venom was not detected after tiger snake antivenom (TSAV) was given. In vitro binding studies demonstrated that TSAV concentrations of 50mU/mL are sufficient to bind the majority of free H. stephensi venom components at concentrations above those detected in envenomed patients (100 ng/mL). Eleven patients received antivenom, median dose 2 vials (Range: 1 to 5 vials), which was TSAV in all but one case, where polyvalent antivenom was used. Immediate hypersensitivity reactions occurred in six cases including one case of anaphylaxis. Envenoming by Hoplocephalus spp. causes VICC and systemic symptoms, making it clinically similar to brown snake (Pseudonaja spp.) envenoming. Based on in vitro studies reported here, patients may be treated with one vial of TSAV, although one vial of brown snake antivenom may also be sufficient. SN - 1879-3150 UR - https://www.unboundmedicine.com/medline/citation/21967812/Clinical_effects_and_treatment_of_envenoming_by_Hoplocephalus_spp__snakes_in_Australia:_Australian_Snakebite_Project__ASP_12__ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0041-0101(11)00289-3 DB - PRIME DP - Unbound Medicine ER -